· By Tiny Hearts Education
After a 3B tear with the birth of my first child, I was very conscious of doing everything possible to avoid a tear the second time around.
Being in lockdown and part of the public system, my initial consultations were with midwives over the phone. As it was my second pregnancy and everything was going smoothly, these calls were relatively short and very relaxed.
It wasn't until my first OB in-person appointment (20 weeks pregnant) that I felt pressure to have a caesarean to avoid a tear during birth. The OB gave me a choice as I had healed and recovered very well after the birth of Hazel, but said if my recovery hadn't been so good that she would be encouraging me to have a caesarean.
The OB got called into an emergency during this appointment, and a midwife took over. She was absolutely fantastic and assured me that I could have a vaginal birth, and there are several things I can do to reduce my risk of a tear. This included perineal massage, using an Epi-No, labouring in water, a water birth and different birthing positions.
I loved the idea of a water birth, and it was something I always wanted, so I tried to change to a sister hospital that had a birthing tub as the hospital I was enrolled into only allowed the tub for labour, not birth. I was unable to change to the sister hospital as it was fully booked #covidbabyboom
There's nothing like moving house when 28 weeks pregnant and with a 15-month-old, but the perk was that it put me into a different hospital zone which was set up for water birth! I transferred my maternity care and was so excited about my water birth.
I rock up to my first OB appointment at the new hospital really excited, only to be told that I cannot have a water birth due to my tear history. I pushed back, and the OB left the room to get the senior OB to discuss my situation further. I had a student midwife following my journey, and I burst into tears with her as I was shattered that they weren't listening to my needs and reasoning. I had done a lot of research and was well educated on the topic.
They had to escalate my case to the OB in charge, who granted me permission to have a water birth… but in doing so, they presented me with a lot of stats and information about why it's not ideal for my previous tear history. Basically, I had a 1 in 10 chance of another big tear, which is the statistic the OBs kept pushing on me (which can lead to many issues later in life). I kept arguing back that I have a 9 in 10 chance that I don't, plus all the other prevention plans I had, which I believed would give me an even better chance of no/minimal tearing. I liked my odds (and so did the fantastic team of midwives).
I can be very stubborn and don't like being told I can't do something, so I was very relieved that I was granted permission to have a water birth and signed all the relevant forms. I had a few big chats with my husband about it as I knew he'd be my voice when I was in labour, and we came up with a different idea. Instead, I would labour in the water to help soften the perineum, but birth in an all-fours position which would enable a midwife to be able to guard my perineum.
In order for my birth plan to go ahead, I wouldn't be able to have the beloved epidural this time around. I loved the epidural with the birth of Hazel!
I purchased an Epi-No (a pump up balloon type contraption to help stretch the perineum), which I started using at 37 weeks. In addition, I listened to a hypnobirthing audiobook and spent my pregnancy 'poo breathing' so I could breathe out the baby instead of pushing.
Throughout my pregnancy, I had terrible back, hip and pelvis pain. I could hardly walk towards the end of my pregnancy, and it made me doubt my physical strength to go through labour without an epidural. He always encouraged me that my body knew what to do, and I'm doing everything I can to help prepare my body.
I had a sizing scan around 34 weeks, and the baby's head was measuring in the 80th percentile. During my 38 week appointment, the baby was posterior. In addition to the tear history, there were a few extra things stacking up that filled me with doubt about whether a vaginal birth was right for me.
Jump forward to 40+2, and labour hadn't started yet. On Monday evening, I had my midwife appointment where I asked for a stretch and sweep.
My dad came over on Tuesday to help me with Hazel as I could hardly move due to back and pelvis pain, and I was having niggles on and off since the stretch and sweep the evening before. 4 pm rolled around, and labour hadn't started, so dad went home.
I had a shower at 8:30 pm, and as soon as the water hit my body, I was having contractions every 3-4 minutes. Throughout my late pregnancy, I regularly felt my cervix to feel if there was anything different to usual, and this time I could feel something hard (which I assumed was the head), and I got so excited that things were starting.
As soon as I hopped out of the shower, I called my parents to come and pick up Hazel so they could take her for the night. Out of the shower, the frequency of my contractions slowed down.
I hadn't felt as many movements as usual throughout the day, so Jacob and I went into the hospital for some monitoring, just to be sure everything was OK. During the exam, I was 3cm dilated. We got home around midnight and hopped into bed for some rest. Being my second pregnancy, I was constantly told that labour could be very quick… after a 66 hour labour with my first; I was hoping this would be the case!!!
I woke around 2 am, and my contractions were jumping around between 2 mins apart up to 6 mins apart. They were consistently inconsistent. Lying down was painful, so I hopped in the shower, which helped. My baby was posterior, so I was mentally prepared for a back pain labour and a long labour while the baby was turning. In the shower, the contractions were every 2-3 mins apart. I freaked out that the baby must have turned, and I was about to give birth, so we went back to the hospital. It was 3 am. They measured me again, and I was 5cm.
I wanted to hop in the bath for labour, but the midwife advised that it was still too early and they didn't want contractions to slow down, so instead, I laboured in the room, either leaning on the bed or sitting on the ball. I was drawn to the water, so I ended up in the shower, which helped. My contractions ramped up while I was standing (and slowed in any other position), so I wanted to stay on my feet to keep things moving.
At one point, I asked for some gas, but the midwife told me I was doing fine without it. I wasn't impressed by this, but was fairly in the zone of labour, and having semi-regular cries to my husband about how much it sucks that my baby was posterior and being so slow to turn, and why couldn't I be one of the lucky ones who have a short labour. Our student midwife kept encouraging me and helping me focus on my breathing and relaxing my shoulders during contractions.
At 7 am there was a midwife shift changeover, and my new midwife was amazing. She gave me gas, reheated the bath (which was ready and had gone cold… the previous midwife never told me it was ready), and really met my needs and followed my birth preference sheet. She was new to the hospital after working at a regional hospital. We felt like her priority was supporting my natural birth experience instead of rushing me in and out.
I hopped in the bath around 8 am, and it was terrific! It helped take the pressure off my back, which was insanely painful after standing for hours and hours and hours in the shower, but my contractions slowed down a bit once I was in there. Either way, I was comfortable, and I ended up in a very calm, gassed up, hypnobirth state. The time in the bath was such a blur for me.
Around 9:30 am, the OB on duty wanted me to hop out of the bath so they could do an exam to see how dilated I was. My waters were still intact, so their next move would be to break my waters. Our midwife was incredible and told me to listen to my body and that I didn't 'have' to do anything I didn't want to do.
By this point, I was over it and doubting myself and just wanted things to move along quicker. However, with the next contraction, I felt my body do a slight involuntary push. This gave me hope that things were close. After a handful more contractions with minor involuntary pushes, I decided it was time to get out of the bath and back to the bed. Before hopping out of the bath, I had a quick internal feel and could feel ahead right there (about half my finger distance away)! I burst into tears as I had done it! I had laboured in the water and with only gas. At that moment, I knew I could do the rest, and I had achieved my birth plan.
It was around 10:15 am when I went back to the room, and I got into position, kneeling against the back of the bed. I had my 'fun' playlist going and kept having involuntary pushes with each contraction (like the involuntary spasm you have when you have diarrhea).
The midwives were worried about me 'pushing' as I hadn't had another exam, so they didn't know how dilated I was… but I kept assuring them that I was not actually pushing and my body was doing everything.
With many involuntary animalistic grunting sounds with each contraction, I told the midwife I was about to do a poo. She told me it was the baby's head, but I assured her it was a poo. I was wrong; she was right! To say I hated this feeling is a huge understatement.
The head was crowning, and I was panting in order to focus on my breathing. With the next involuntary spasm, the head came out, followed immediately by the body. With the midwife guarding my perineum, my husband caught our baby and handed him over to me. It was a boy! A beautiful, healthy baby boy, born at 10:55 am.
I think it's important to note how unhappy I was post-birth. Yes, I had achieved everything I wanted, but my body was so sore (remember earlier how I could hardly walk due to back, hip and pelvis pain? This pain didn't immediately go away after giving birth). I was also traumatised by the pressure of the head. The ring of fire didn't bother me, but the head pressure did. It took me about 24-36 hours before I could be proud of myself for what I achieved and sticking it to everyone who said I shouldn't do a vaginal birth after a 3B tear.
The preparation I did helped my perineum. I sustained a stage 1 internal tear and grazed labias, but my perineum was fully intact. The grazed labias stung so badly, but after a day or two, they had healed.
Finn Archer was born 9 June 2021, 3.62kg, 50cm long, and 35cm head. He was worth every second of the 14.5-hour labour, every argument for my right for a vaginal birth, and every tear shed throughout the pregnancy. My back and pelvis are still healing, but my vagina/perineum is great. Finn is our little slice of heaven.
I share my story to provide hope that you can have a vaginal birth after a 3B tear.
I share my story on finding a balance between the advice given to you, but to make a decision that you know is best for you.
I share my story as neither of my labours are in line with textbook contractions timing.
I share my story as my waters didn't break until minutes before the head emerged (and it was only a trickly that came out, and the rest came out after the baby).